Journey to Here

For those that missed the past two years of my life, here follows a brief synopsis.

September 2006: Sweet Innocence

I get thinking about getting pregnant (better start early as we want a big family) and my sister’s PCOS tickles the back of my brain.  I go see my GP and ask him if I should be concerned and maybe start earlier, rather than later, just in case this PCOS thing is a problem for me as well (it wasn’t so much for my sister, but I knew she had it).  GP is not phased at all, and informs me that reproductive technology has advanced to such an extent that women are having kids into their 40’s.  I should not be worried.  Be merry, enjoy one another and worry about having kids a little later, your time will come.  Don’t sweat it, it’s childsplay, and ever so much fun!

October 2006: The Check-up

I go see Gynie to check up my lady bits. All seems in order.  One vagina, one uterus, two ovaries, no infections, all the necessary childhood innoculations.  Brilliant!  We should be careful, we could fall pregnant!  What if it happended too soon?!  Maybe I should go do my honours degree first? I cling to my BCP religiously!

November 2006: Living Dangerously

We decided we’d like to be more than 2 in the house, we’re going to begin living on the reproductive edge.  I tossed my stash of birth control pills in the trash, and emailed DH my ‘green dates’ for the next three months. (you have to be impressed with my impeccable planning, or frightened…).  DH found it rather amusing and shared with a friend, which I did not find very amusing, we had a fight, we made up, we made loooovre…Barry White kinda looovre….pre-TTC kind of looovre…

December 2006: TTC is Fun!

We spent our holiday with the inlaws.  TTC is really fun sleeping next door to your MIL…(see what I mean with living on the reproductive edge…)  Anyhow, DH, knowing himself to be the most fertile male on planet earth decided in his eagerness and naïveté, that making the entire family understand that we are going to build a family, is a good idea, just so that they will know how super fertile we are when we fall pregnant just the next month (is it only me, or do you sense a hint of competitiveness?).  O right, it’s just me…. I spend Christmas googling “early pregnancy symptoms” to such an extent, that Google bans me and asks me to “please confirm the characters in the security image” … you’re googling like a machine Mrs. Botha, please confirm that you aren’t a robot.

Jan 2007: A little more In-Depth

Seeing that month 1 and 2 didn’t succeed, I take things a bit further and try to figure out how this 14 day thing fits into a 35, 38, 40 and 50 day cycle.  I’m quite relieved to discover that I should’ve been couning backwards and not forwards.  I nailed it, BFP, here we come!  Psuedo green dates however remain very exciting times…Dh still finds it very difficult to understand how one can only be fertile on certain days of the month.  Teenagers fall pregnant all the time, from one accidental roll in the hay, hey! we’ll manage without your calendar dear…

Feb 2007: Strange Suspicions

It dawns on me that my cycles aren’t as perfectly symetrical as one might desire, they’re a little erratic and unpredictable, the Jackson Pollock of menstrual cycle art. I google, to much of DH’s frustration, every single search term in reproductive science.  I do a lot of internal lobbying to get the concept of timed intercourse accross, I mostly fail and decide that sneakyness is in order of the day.  I mostly succeed.

March 2007: Suspicion Grows

February all over again.

April 2007: Suspicion Grows some more

March all over again.

May 2007: Reasonable Doubt

I decided I have grounds for reasonable doubt and hop off to my gynie for some advice. First Clomid Timed Cycle (50mg), nothing much happens.

June 2007: Hope’s Executioner

Second Clomid Timed Cycle (100mg), nothing much happens.

July 2007: FS = Fertility Specialist

Gynie gives up, sends me on to their resident FS.  First Clomid with Gonal F IUI.  Here I’m introduced to big guns of ovulation induction, injectable Follicle stimulating hormones.  I nearly faint, nervously doing my first injection all by my lonesome self in the wee hours of a cold winters morning.  I’m now officially a teenager in the world of infertility.  I do my own shots.  Great.  My response looks good, but not great.  I am however pleased and relieved that I am at all capable of producing a follicle, however meager.  Excitement hanging thick in the air.  This is it, this is all we need, we’ve got follicles, we’ve got sperm, halleluja!  I await my hCG test date with glee, I compose my pregnancy anouncement.  It fails. I’m broken.

August 2007: Injections = Follicles, Hope’s Revival

Second Clomid with Gonal F IUI.  We up the meds to get a better response.  It works! I’m addicted. Big fat follicles all over the show! Dr. give me more of that! I like. Excitement hanging thick in the air.  This is it, this is all we need, halleluja!  I await my hCG test date with glee, I compose my pregnancy anouncement.  It fails. I’m broken.

September 2007: Taking Charge

Third Clomid with Gonal F IUI.  Lots more injections and lots more scepticism.  Pessimism hanging thick in the air.  Round abouts this point I get overwhelmed by the lack of empathy from medical staff at my clinic and request a copy of my file for my personal use.  I have a little run in with a difficult receptionist who seems to think that I’m only entitled to SOME pages of my medical files.  Dr’s notes are stricly confidential and not meant for general consumption.  I’m miffed.  If my Dr. is not confident enough to release his notes, I’m not quite confident in his competence. I send an erratic email off into cyberspace and pray…

Dr. V,

I’m currently receiving treatment at xxx with Dr. x  Doing my third IUI next week.

I ended up seeing Dr.x pretty much by default, GP referred me to Dr.a and Dr.a (after clomid treatment) to Dr. x.  I have experienced some frustration with the staff at x with simple things like receiving blood results in a timely manner, not feeling comfortable phoning for advice, etc.

I am now at a point where I’m wondering whether I should not be making a more informed decision on treatment.  I do respect Dr.x, but the comments from staff that he is overloaded and overworked makes me uncomfortable, there’s just something about the setup that makes me feel unsettled.  It just does not feel like I’m in control of the situation and I don’t think it can be healthy to just stick around because that is where the “system” sent me.

I know this is a difficult question to ask you but what do you recommend in my situation, should I stay on for another cycle and see if things improve, should I first talk to Dr.x …when does one make the decision to move on…and am I even assured moving on to a clinic like Vitalab will be any better?  Should I stay with Dr.x because he knows my history (which is not too complicated) …?

Your clinic is mentioned quite frequently on online forums and never in a negative sense, not that I’ve read of anyway.  Does it take a long time to get an appointment at Vitalab?

Your advice is appreciated.

Kind Regards,

Maritza

Within the hour, his response:

Dear Maritza,

Thank you for taking the time to send us the e-mail detailing your thoughts and concerns. Infertility is a very sensitive and emotional issue for all parties concerned. Therefore it should be managed in a manner that is always sensitive to the couples feelings and needs. At Vitalab, we therefore try to go the extra mile to ensure that it is treated in such a manner.

It is very difficult to tell you or suggest to you what you have to do. However, due to your concerns, it might be wise to go for a second opinion and there after, make an informed decision. Going for a 2nd opinion does not mean that you have lost confidence in your treating physician, it merely gives you more options and the ability to make an informed decision.You can always return to continue your treatment, knowing that you have explored all the options. Our books are relatively full, but should you be interested, I can always make a plan to suit your requirements.

Kindest regards,

I’m slightly shocked, pleasantly surprised, nearly in tears and very intrigued by a Dr. that actually responds on his email.  ”we therefore try to go the extra mile to ensure that it is treated in such a manner…..I can always make a plan to suit your requirements.” I’m sold, lock, stock & barrel.

Still going ahead with my IUI sheduled at my current clinic, after my second insemination I mention to my then current Dr.X that I’m feeling a bit sore and uncomfortable (translated into “normal people talk”: Dr, I’m about to explode with pain).  Dr.X recons it’s completly normal and I can go ahead with life as ussual, heck, even go to the gym if I like.  Ok, Doc, I don’t know through which military program you went, but it sounds a little inhumane to me…

I’m not too concerned though ’cause in the back of my mind I know I have an appointment with Dr.V just the next day, how convenient.

Next day at Dr.V we do an internal ultrasound and he quite enjoys showing his support nurse the circus going on in my insides, he even prints a picture for posterity.  ”Dear Maritza, you have what is known as OHSS (Ovarian Hyper Stimulation Syndrome), please stay in bed and drink at 5L of fluid daily until your symptoms subside.  Please note that you are at risk of ovarian tortion so try not to stretch too high and generally, just take it easy.” Ok, finally, a language I can understand, pain = danger. I think I like this Dr.

Back in his office we discuss the events that transpired during my treatment with Dr.X and exactly which parts of it counters their standard practice.  I beg him not to send me back to clinic x, he tells me it’s all up to me and should I make the decision to stay with them they will indeed take good care of me.  I’m quite relieved that I don’t need to pass some kind of blood test to receive treatment at their clinic.  I have renewed hope and an extremely bloated and sore tummy.

October 2007: OHSS Recovery

I take 2 weeks to recover.  hCG Negative. Yet again, not pregnant.

November 2007: The Healthy Living Band Wagon

Waiting for AF. I climb onto the healthy living band wagon, go see a dietician and do all the lovely things required of me – eating a low-GI, low Sugar diet.  I lose a bit of weight.

December 2007: Bloods & Hedonism

Standard fertility blood workup. I go on holiday, lose track of my diet.

Jan 2008: The HSG

I go for my first HSG – all normal. I jump back on the healthy living band wagon, go see a dietician and do all the lovely things required of me – eating a low-GI, low Sugar diet.  At this stage I decided to take the healthy living thing one step forward.  Seeing that I am entirely incapable to keep to an excercise programme by myself I enlist for the services of a personal trainer (one of the best and most productive decisions I’ve made on my whole journey). I train three times a week religiously.  I eat reasonably healthy.

February 2008: Natural Ovulation!

Still on my training and healthy eating programme I Ovulated, for the first time (under observation) on a natural cycle.  We had intercourse on all the right days, a blood test confirms ovualtion. I wait, I test, once again a BFN (Big fat Negative)!  Now ladies and gentlemen, at this point one gets a little frustrated with the whole scenario, you’ve got eggs at the right time, you’ve got open tubes, you’ve got sperm at the right time, why on earth still a negative result!

March 2008: Experiment Letrozole, the last straw

In a consult with Dr.V we decide we’ll play the conventional game.  Do a few cycles of very gentle stimulation Letrozole and IUI.  After the first cycle fails I tell Dr.V – this is it!  We’ve played this game enough times now.  We’re fed up, physically and emotionally, we’d pay big bucks to just not have to do this timed intercourse thing anymore.  We’re finished!  We’re tired.  It seems not to be working.  We want out.  Bring on the big guns.

April 2008: Down Regulation

I go on the BCP (Birth control pill) for down regulation (quieting the ovaries down) to prepare for IVF#1.  I also go on Metformin, which puts an end to my training programme because of ill health.  I stop taking Metformin due to intollerance and it takes me quite a while to return to my normal self.  I didn’t go back to training.

May 2008: A Depressed Traveller

I spend much of May traveling with my husband on business in the Western Cape.  No special diets, no exercise.  The run up to this IVF gets me under as I suffer from bouts of depression.

June 2008: IVF#1

Enter June - IVF # 1.  My enthusiasm for life returns as my frustrations are relieved by being engaged in treatment.  Finally we’ll be doing a treatment with decent success rates.  I’ll stand in line for 50% any day! I stimulate well, we retrieve 12 eggs, 5 normal fertilisations and we end up with one decent and one semi-decent day 5 blastocyst.  We transfer both.  In my 2ww I’m tormented with fears that my eggs are all worthless.  Dr.V assures me that this is not the case.

July 2008: Depression Reigns

Processing Failed IVF#1.  Depression sets in as the shock of the negative IVF finally hits home.  I battle my way through the month setting my sights on IVF#2.

August 2008: Gym Bunny

I keep myself occupied by focusing on my health and training 3 x weekly with my new trainer.  I’m now also on Actos, for the treatment of PCOS related insulin resistance, no side effects, what a relief!

September 2008: Gym Bunny, all new and improved

Still sticking with my training program and reasonably healthy diet, I now am pretty fit and my fitness translates to a more positive outlook.  I feel rejuvenated and the after efects of IVF#1 is finally in the past.  I feel like I can move forward in a good mental space.  Round abouts this time I come to the realisation that I need to approach my infertility with a looser grip.  Like the chinese finger trap, the harder you pull the tighter it grips.  I realise for the first time that the only way I will survive this without burning out time after time is to prepare myself for the worst and not try to run the 10 mile desert run in 10 seconds.

October 2008: IVF#2 Menopur Rocks!

IVF#2.  We decide to change my protocol to exclude clomid and only use Menopur.  The protocol turns out to work wonders.  We retrieve 21 eggs, 14 normal fertilisations, 10 good on day 3, transfer 2, freeze 8.  I experience severe pain (over stimulated ovaries) from day 4 post transfer onward to day 7, practically bedridden.  Pain subsides on day 8.

November 2008: A little bit lost

IVF#2 Turns out negative.  I question myself, question my choices and have one mother of an existential crisis.  Everything is worthless, what is the purpose of anything if I can’t share the future with a family, grow in life and love as it was intended for us all.  Why all this wasted pain and energy?  If someday, then why not today, when it feels so right on time?  I’ve always been blessed, despite hardship, but now it feels like the river has run dry.  Has God fallen deaf to my prayer? Have I been forsaken? Where do I turn, what do I do?  Despite all these fearful and terrifying thoughts, I know I should preservere, I know things could’ve been worse, I know it will happen one day, or rather I hope.

December 2008

La la la…giving the body some rest and recovering psychologically by sharing our beach house for the holidays with my sister and her newborn (and 3 kids) and my newly pregnant sister in law.  Stories of offspring abound as everyone enjoys the holiday season with extended family.  My favourite time of the year.

January 2009

Glory halleluja! Back in my comfortzone.  No constant reminders of babies and children and the like.  Home sweet home.  We proceed to prepare for our first FET on a natural cycle.  The natural cycle idea crashes and burns when my E2 results come back too low.

February 2009

This time round we add Femara to the FET mix and all goes well.

March 2009

2009/03/03 we transfer 3 embryos, testing 2009/03/17. I keep hoping that the lack of hard core fertility hormones will make all the difference. To no avail. BFN

April 2009

Downregulation on the BCP preparing for GIFT#1

May 2009

Downregulation on the BCP preparing for GIFT#1

June 2009

GIFT#1 with intralipids progresses well until my E2 levels skyrocket to 15 000 and suddenly drops to 1000 for no apparent reason.  After much deliberation we decide to cancel the cycle.

July 2009

Downregulate for 28 days to quiet down my ovaries. We proceed with GIFT #2 with Intralipids. 17 eggs were retrieved. 5 placed back and the rest IVF’ed, only one of the remaining 12 embryos reach 8 cell stage. I lose quite a bit of confidence, wondering what the odds are of a pregnancy with such poor stats from the lab embryos.

August 2009

On 20 August at 3.15 am, the day prior to my scheduled beta I do a urine test and test positive. Beta test result later that day = 640!